Endocrine Abstracts (2016) 44 P126 | DOI: 10.1530/endoabs.44.P126

Radiological surveillance in multiple endocrine neoplasia type 1: A double edged sword?

Ruth Casey, Debbie Saunders, Ben Challis, Deborah Pitfield, Heok Cheow, Ashley Shaw & Helen Simpson

Cambridge University Hospital, NHS Foundation Trust, Cambridge, UK.

Multiple endocrine neoplasia type 1 (MEN1) is a hereditary condition characterised by the predisposition to hyperplasia or the development of solitary adenomas of multiple endocrine gland. MEN1 related disease is responsible for death in two thirds of patients with this hereditary condition and the mean age at death is 55 years. This associated mortality necessitates a vigorous surveillance protocol, however all recommendations for radiological surveillance are based on non-prospective data and the clinical practice guideline recommendations were made despite a reported lack of consensus on the optimum radiological surveillance. This in mind, we sought to determine if cumulative radiation exposure as part of the recommended radiological surveillance programme posed a distinct and independent risk in this cohort of patients with hereditary endocrine neoplasia. A retrospective review of patients with MEN1 attending our institution was carried out and demographic and clinical information including clinical phenotype was obtained on all patients. A review of all radiological procedures performed as part of MEN1 surveillance between the time period; 2007–2015 was performed and an estimated radiation effective dose (ED) for each individual patient was calculated. A total of 43 patients were included in this study. The mean ED was 121 mSv and the estimated mean lifetime risk of cancer secondary to radiation exposure was calculated as 0.49%. Patients with malignant neuroendocrine tumours (NETS) had significantly higher ED levels compared to patients without metastatic disease (P-value <0.00002) and functional pancreatic neuroendocrine tumours (PNETS) were also associated with a higher ED (P-value 0.002). This study is a sharp reminder of the effects of long term radiological surveillance and the need for a multi-modality imaging approach to reduce exposure to ionising radiation in patients with hereditary cancer syndromes requiring life-long follow up.

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